Ultrasensitive PSA Test Post RP

Posted by tcanavan @tcanavan, Aug 11 12:59pm

RP Gleason 7a. Operation 04.04.2022 USPSA post op 04.06.2022. <0.005 and 28.07.2022 0.0010. I am a bit shocked at the rapid increase in such a short period.
Should I be worried?

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I'm gonna guess this is a typo? You went from .005 to .001 in 2 mos? That's a decrease.

If it went from .005 to .010 in that time, I'm not sure about worried, but it's something your dr is going to discuss with you. Maybe consider some type of ongoing treatment if it continues.

One of the statements my radiation oncologist made to me was that rate of doubling in those very low numbers such as you're in is not nearly as troubling as in the higher numbers, i.e. 2 going to 4 etc.

I went from .039 to .091 and it indicated going for radiation treatments and ADT. Last one is tomorrow. With your numbers being so low to start with, it's likely less significant, but, there are others here who have studied this a great deal more than I. Hopefully someone will have something more definitive for you soon.

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@web265

I'm gonna guess this is a typo? You went from .005 to .001 in 2 mos? That's a decrease.

If it went from .005 to .010 in that time, I'm not sure about worried, but it's something your dr is going to discuss with you. Maybe consider some type of ongoing treatment if it continues.

One of the statements my radiation oncologist made to me was that rate of doubling in those very low numbers such as you're in is not nearly as troubling as in the higher numbers, i.e. 2 going to 4 etc.

I went from .039 to .091 and it indicated going for radiation treatments and ADT. Last one is tomorrow. With your numbers being so low to start with, it's likely less significant, but, there are others here who have studied this a great deal more than I. Hopefully someone will have something more definitive for you soon.

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Thanks for the feedback. Sorry for the typo you are correct it is 0.010.

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There is still much discussion about USPSA tests and what changes mean compared to conventional PSA tests that only measure to single decimal.

There can be variation in lab results. Some factors may be if different labs are used, type of assay, calibration of equipment as well as the conditions, were you dehydrated, ore lab routine, did you intensely exercise prior, is the lab the same time of the day…

So, a change from .005 to .01 may mean different things. One thing is may not mean is a call to action, treatment! What you may want is multiple readings over time, say three, stretched three months apart that indicate a continuous upward trend. web265 is correct when he cites his radiologist – One of the statements my radiation oncologist made to me was that rate of doubling in those very low numbers such as you're in is not nearly as troubling as in the higher numbers, i.e. 2 going to 4 etc. As you can see from my attached clinical history, my PSA has bounced around since triplet therapy starting in Jan 17 through Nov 18 after surgery and SRT failed but my medical team has not felt there is a reason to act given its variability and low levels.

We do know there may come a day where that variability ends and there is a need to act. What might that day be? Well, PSA would have to hit .5 a continue to climb, why, well that's the earliest we would image endeavoring to locate where the recurrence might be. No treatment decision unless we know where it is! Belo .5 the newer imaging has <30% chance of locating the recurrence.

Another thing to think about is does acting now or waiting until you have more clinical data supporting a decision change the outcome, you and your medical team's treatment decision. Before USPA tests or if your medical team was not using USPSA then the decision criteria for recurrence was a detectable PSA defined as .2 followed by a 2nd rise that showed .3 or higher. So, by that standard, you are undetectable!

Consider to continue actively monitoring your PCa, decide if it continues to increase, what constitutes a decision to treat – I would consider not treating until I had imaging to inform the decision and for me and my medical team, that comes somewhere between .5 and 1. If there is clinical data to support a treatment decision, hit it hard with double or triple therapy.

Kevin

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@kujhawk1978

There is still much discussion about USPSA tests and what changes mean compared to conventional PSA tests that only measure to single decimal.

There can be variation in lab results. Some factors may be if different labs are used, type of assay, calibration of equipment as well as the conditions, were you dehydrated, ore lab routine, did you intensely exercise prior, is the lab the same time of the day…

So, a change from .005 to .01 may mean different things. One thing is may not mean is a call to action, treatment! What you may want is multiple readings over time, say three, stretched three months apart that indicate a continuous upward trend. web265 is correct when he cites his radiologist – One of the statements my radiation oncologist made to me was that rate of doubling in those very low numbers such as you're in is not nearly as troubling as in the higher numbers, i.e. 2 going to 4 etc. As you can see from my attached clinical history, my PSA has bounced around since triplet therapy starting in Jan 17 through Nov 18 after surgery and SRT failed but my medical team has not felt there is a reason to act given its variability and low levels.

We do know there may come a day where that variability ends and there is a need to act. What might that day be? Well, PSA would have to hit .5 a continue to climb, why, well that's the earliest we would image endeavoring to locate where the recurrence might be. No treatment decision unless we know where it is! Belo .5 the newer imaging has <30% chance of locating the recurrence.

Another thing to think about is does acting now or waiting until you have more clinical data supporting a decision change the outcome, you and your medical team's treatment decision. Before USPA tests or if your medical team was not using USPSA then the decision criteria for recurrence was a detectable PSA defined as .2 followed by a 2nd rise that showed .3 or higher. So, by that standard, you are undetectable!

Consider to continue actively monitoring your PCa, decide if it continues to increase, what constitutes a decision to treat – I would consider not treating until I had imaging to inform the decision and for me and my medical team, that comes somewhere between .5 and 1. If there is clinical data to support a treatment decision, hit it hard with double or triple therapy.

Kevin

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Thanks for the excellent answer. This is great information

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With testing every three months post-prostatectomy, my PSAs varied in the 0.02 – 0.04 ng/mL for about a year, then finally dropped to undetectable where it has remained for the last 5 years. PSA pre-surgery was 7.4.

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My PSA is .2 -but found out that you shouldn’t track only by PSA follow with PET scan
Any comments? As to when PET scan should be done and how often?

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@henryd

My PSA is .2 -but found out that you shouldn’t track only by PSA follow with PET scan
Any comments? As to when PET scan should be done and how often?

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Mayo wanted to do C11 Choline scans every six months.

The challenge is, if there is no clinical data indicating recurrence, a rising PSA that meets accepted definitions of recurrence, your insurance company may balk at "authorizing" and paying for the scan(s).

You may want to look at the NCCN guidelines for imaging in PCa, if you meet those then you have a better argument if your insurance company balks.
https://www.nccn.org/guidelines/recently-published-guidelines

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@tcanavan

Thanks for the excellent answer. This is great information

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Yes excellent answer. I still don’t understand why the ultra sensitive test is done. None of my doctors both at MD Anderson and now Dr.Kwon at Mayo have recommended it. Seems like all it can do is add worry and possible over treatment. Jumping the gun with treatment for a cancer that may not be there has it’s harmful results also. Long term use of ADT drugs is not good for the rest of the body that’s for sure.

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I am a patient with low stable PSA after a RALP in May of 2016. My current PSA is .07. It has been as high as .11, it has fluctuated up and down. I found a paper that Has been encouraging to me. The title is: "Low Stable PSA after Prostatectomy – watch or treat?" by Koulikov et al.

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